Provider Demographics
NPI:1609652635
Name:DR.MANN FAMILY DENTAL CARE LLC
Entity type:Organization
Organization Name:DR.MANN FAMILY DENTAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AJAYPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-836-4225
Mailing Address - Street 1:507 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:WI
Mailing Address - Zip Code:54023-9731
Mailing Address - Country:US
Mailing Address - Phone:262-836-4225
Mailing Address - Fax:
Practice Address - Street 1:507 CHERRY LN
Practice Address - Street 2:
Practice Address - City:ROBERTS
Practice Address - State:WI
Practice Address - Zip Code:54023-9731
Practice Address - Country:US
Practice Address - Phone:262-836-4225
Practice Address - Fax:715-600-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-05
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental